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Self Test

This self-test is not intended to be used for the diagnosis or treatment of any medical or emotional condition. We advise you to consult your doctor about any concerns you may have regarding this questionnaire.

The purpose of this survey is to give you some insight into whether or not you may have a problem with Alcohol and/or Drugs.

Print out this page and mark the appropriate button with your answer. If you would like some literature sent to you or to be contacted by NDFW Please fill out your name and address on the "Contact Us" form.

Do you lose time from work due to your drinking or drugging? YES NO
Is your drinking/drugging making your home life unhappy? YES NO
Do you drink or drug because you are shy with other people? YES NO
Is drinking or drugging affecting your reputation? YES NO
Have you ever felt remorse after drinking or drugging? YES NO
Have you gotten into financial difficulties because of your drinking or drugging? YES NO
Do you turn to lower companions and inferior environment when drinking or drugging? YES NO
Does your drinking or drugging make you careless of your family's welfare? YES NO
Has your ambition decreased since drinking or drugging? YES NO
Do you crave a drink or a drug at a definite time daily? YES NO
Do you want a drink or drug the next morning? YES NO
Does drinking or drugging cause you difficulty in sleeping? YES NO
Has your efficiency decreased since drinking or drugging? YES NO
Is drinking or drugging jeopardizing your job or business? YES NO
Do you drink or drug to escape from worries or troubles? YES NO
Do you drink or drug alone? YES NO
Have you ever had a complete loss of memory as a result of your drinking or drugging? YES NO
Has your physician ever treated you for drinking or drugging? YES NO
Do you drink or drug to build up your self confidence? YES NO
Have you ever been in a hospital or institution on account of drinking or drugging? YES NO
     
     
If you answered YES to any one of the questions, there is a definite warning that you may be an alcoholic.
     
If you answered YES to any two, the chances are that you are an alcoholic.
     
If you answered YES to three or more, you are definitely an alcoholic.
     
(The above test questions are used by Johns Hopkins University Hospital, Baltimore MD., In deciding whether or not a patient is alcoholic.)
     
If you would like some literature sent to you or to be contacted by NDFW Please fill out your name and address on the "Contact Us" form.
     

 

Alcohol & Drug Treatment Services | A non-profit corporation
2607 Willo Lane,  Costa Mesa, CA  92627 | 1-800-93-WOMEN or 1-800-939-6636
contact@newdirectionsforwomen.org
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